The procedure will be conducted in an angiography suite (“cath lab”) at Mercy Angiography, which is in the Mercy Hospital at 98 Mountain Road, Epsom in Auckland. Your Interventional Radiologist will be assisted by nurses and other highly trained staff.
SIRT normally involves two separate procedures. The first procedure is a preparation or work-up stage and in the second phase delivery of SIR-Spheres® occurs.
Preparation ("work-up") - Stage 1
You will be awake during the procedure but may be lightly sedated. Your groin will be numbed with local anaesthetic before the catheter is introduced. You should not feel pain at the entry site but there still may be some non-painful sensations such as pressure. You cannot feel the catheter moving inside your arteries.
A tiny plastic tube called a catheter is introduced under local anaesthesia through a tiny incision (less than 6mm) in the groin. Your interventional radiologists watches the catheter on an x-ray screen as he passes the tip of the catheter through your femoral artery guiding it to arteries supplying your liver. A special fluid (contrast or dye) is injected and a movie picture is recorded as the dye flows into the artery and its branches and makes them visible on the fluoroscope's monitor.
The contrast media makes vessels supplying the tumour "light up". The interventional radiologist identifies and maps the vessels leading to and from the tumour. Once vessels leading to other body parts (stomach or intestines) from the liver are identified he then injects the branches with tiny particles or coils to block those branches, thereby reducing the possibility of the radiation spheres affecting other organs of the body.
The radiologists then inject a small amount of radioactive spheres (MAA) which is called a tracer and acts in similar manner to the SIR spheres®. Following this, you will be transferred to NZ Medical Imaging for a scintiscan scan for the tracer to observed and to predict the behaviour of the actual SIR spheres® when they are injected.
After the scintiscan you will be observed for 4 hours before being discharged.
Following the phase I procedure, your doctors study the x-ray images and scintiscan scan reports to determine suitability for you to receive SIR spheres®.
Delivery of SIR Spheres - Stage II
This stage II procedure usually takes about 7 to 10 days after the work-up stage. The second procedure is exactly like the first procedure with the exception of the SIR spheres®. Again you will be awake during the procedure. You will be given some relaxing medications during the procedure. Access to your liver artery will be done the same way as your initial procedure where the radiologists numbs your groin with local anaesthetic and introduce a plastic tube through tiny incision in the groin.
Under x-ray guidance the plastic tube (catheter) is passed through the femoral arteries to be positioned in the liver arteries close to the liver tumours. Once in position, the SIR spheres® are infused through the catheter into the arteries. The SIR spheres® are prepared by Nuclear Medicine and brought to Mercy Angiography in a special Perpex box on the day of your procedure. The catheter is then connected to the Perpex box to begin infusion. The radiologists inject contrast media in between infusions to check the position of the catheter.
Once infusion is complete, the catheter is removed. Pressure is applied for approximately 10 minutes on the groin to stop bleeding. During infusion you may experience slight pain or nausea. In these instances you will be given medications to make you as comfortable as possible.